ABSTRACT In surgical education, an apprenticeship model has long been traditional. However, this model is increasingly being challenged due to the rapid development of increasingly complex and minimally- invasive procedures that are associated with steep learning curves and cannot be adequately and efficiently mastered via current education in the operating room alone. Surgical-skills simulators provide a potentially important educational tool. Clearly, simulators as a new teaching tool require extensive validation prior to wide introduction into residency education. In orthopedic surgery, previous studies of simulators have demonstrated that subjects who are more skilled in clinical arthroscopy also perform better on the simulator, but the reverse has not been proven conclusively - that subjects trained on the simulator subsequently perform better in clinical arthroscopy. If this can be demonstrated, then residents could be trained on a virtual reality simulator prior to performing the first arthroscopic surgery on a live patient, analogous to pilots receiving flight simulator training before taking control of an airplane, thus improving patient safety, as well as surgical education. We propose a preliminary study to begin to directly investigate effects of simulator training on subsequent arthroscopic skills of novice orthopaedic residents (recruited over two years from the Harvard Combined Orthopaedic Residency Program). Specifically, we propose to randomize 28 orthopaedic residents, with no previous arthroscopic training, to 6 weeks of simulator training or no training;at the end of the study period, we will compare their performance in actual shoulder arthroscopy in an in vitro cadaver model that closely mirrors the clinical situation in the operating room. Our hypothesis is that residents who receive shoulder arthroscopy simulator training will perform arthroscopic shoulder surgery in a more efficient and technically competent manner than untrained controls. This preliminary study will provide important data to substantiate a larger-scale study, with the eventual possibility of validating the design of current arthroscopy simulators and providing substantial benefits to orthopedic education and patient safety. PUBLIC HEALTH RELEVANCE: PROJECT NARRATIVE We propose a randomized trial to examine the effectiveness of virtual reality simulator training to teach arthroscopy to orthopaedic residents. Simulator training for residents, equivalent to flight simulator training for pilots, has the potential to improve patient safety in the operating room, as well as enhance resident education.